In this article I attempt to identify the tasks and objectives that NEHTA should be addressing rather than what is presently happening. The strategic perspective I am adopting is one that says there are two key priorities for virtually all health service organisations and that NEHTA’s efforts should be predominantly focussed on supporting, enabling and facilitation these two (urgent) priorities.
The two key priorities are that first health services should be safe and effective and second that health services should be economically efficient while being equitably accessible and distributed where ever that is possible.
The implications of ‘safe and effective’ include that no unnecessary harm is done, that needed treatments are not omitted and that where possible the care provided is based on up-to-date evidence. There is an implicit implication here that recognises that modern clinical practice is so complicated that only with automated support and well designed systems (both manual and electronic) can ‘safe and effective’ care be demonstrably delivered. Another clear implication is that all deliverers of care must be provided with the best possible tools and circumstances to ensure their patients have the best outcomes.
Efficiency and equity of access I would suggest are matters of common sense and common humanity. We should not be wasteful in delivery of care and we should ensure that all who need care can receive it without unreasonable delay.
Secondary priorities include the collection and management of information that both permits and enables the health system to operate in a coordinated and coherent fashion, be well managed and have a sensible balance between preventative and curative care.
Un-stated, but implicit in all of the above, is that everyone touching the health system is treated with respect, compassion and that their personal privacy and individual autonomy is fully respected and guarded.
NEHTA’s mission should be identify, specify, define and recommend the attributes of the Health IT systems required to optimally support the overall health system which has these objectives and goals. This it should be doing by working with the relevant stakeholders (including clinicians, relevant service providers (Pharmacists, Laboratories, Radiologists etc) ,Health IT providers, Health Departments and Institutions and consumers) to identify out what is needed and then develop innovative ways to have such systems delivered and a coherent fashion.
It seems to me, based on the Rapid Learning Approach identified in two recent blog entries, that where the main value lies is not so much in having systems, but having them actually used in the delivery of care. This means we need usable, quality systems, with rich functionality in decision support etc, in use in our General Practices, Specialist Offices and Hospitals. We also need to have them communicating successfully and safely the clinical information needed both to deliver care and understand what is happening out in ‘the field’. The systems also need to be able to ‘take care of business’ and thus appropriate links to Medicare Australia and other funders are important.
Additionally careful analysis of referral and prescription information and the associated systems is important. Also it is important not to ignore the needs of the public health sector in monitoring illness and warning of possible bio-terrorism. Analysis of where technology can assist in delivery of mental and aged care services is also needed urgently – although much is already known much of the relevant information seems a little fragmented at present in Australia.
On the basis that we know all provision of all the necessary systems is doable the first major task for NEHTA should be to develop a the National E-Health Strategy and Business Case and Broad Implementation Plan that, treating the health system holistically, maps a practical achievable and incrementally achievable roadmap of activities and investment.
Secondary activities should centre around utilising the work done both here and overseas to define and specify functionally the minimum standards for GP, Specialist, Hospital and Ancillary Systems. The CCHIT model in the US is one to consider with relevant changes to suit local conditions and business requirements for certifying systems once the system capabilities and connectivity is defined.
With hospital systems it may be valuable to develop common specifications against which State health systems can conduct procurements. Such systems are major investments and no doubt support from a skilled national entity would be welcome.
In essence what I am suggesting is that NEHTA should be working to ensure, as quickly as possible, quality systems are certified and health providers are able to procure / purchase them in the confidence they will be fit for purpose and deliver the benefits expected while having the basic levels of interoperability needed to enable practical information flows and clinical messaging around the health system. Note I am also keen that key enabling work, terminologies etc, also continue and that NEHTA be resourced to ensure deadlines promised to the Health IT community are actually delivered. That way the available products will be so much better!
It is up to the Health IT system providers to offer competent certifiable products and services and the health system to address how best to facilitate the required investment and ensure benefits are distributed to those who incur the costs and undertake the additional work.
I recognise that this outline is very high level and will require major change management. However, nothing here ‘rocket science’, the technologies are proven and implementable and the risks can be managed reasonably easily. Additionally the implementation can be phased and incremental so mistakes are learnt from and risk further minimised.
An approach of this type could, in a five year time frame, dramatically improve the safety, effectiveness and manageability of our health system. It would be good if NEHTA just forgot about identity management (others are doing it), academic interoperability frameworks, shared EHRs and the like for this period and facilitated getting the basic proven technologies implemented and used. Once the local operational systems of high quality are in place the challenge of enhanced information sharing can be addressed incrementally over time – just as is happening elsewhere in the world (witness the ground up Regional Information Network Approach in the US and the scaling back of the information content on “the Spine” in the UK NHS)
David.
6 comments:
The Australian Law Reform Commission held its first public forum in response to Issues Papers 31 & 32 of the Review
of Privacy. The four speakers on the panel each gave a presentation, and then answered questions. They were Les McCrimmin (ALRC), Sam Ricketson (Victorian Law Reform Commission), Catriona Lowe Consumer
Action Law Centre) and Lisa Thomson (Chief Privacy Officer, National Australia Bank). The 28-page booklet has four pages on privacy and health. The (excellent) powerpoint by Lisa Thomson included the headlines of recent examples of health data getting into the wrong hands.
There wasn't a big crowd, maybe 50, and I guess more insiders (legal, privacy officers, academics) than ordinary citizens. One woman spoke passionately about her experience of discovering that her illness (cancer) was the vehicle for her name being put on a cancer registry, without her knowledge (let alone consent). This anecdote, and four other responses mentioned in the booklet, go right to the point of where NEHTA should be heading. People are going to complain, and react vigorously, when they discover their personal data is in the hands of people and corporations, without their explicit consent. I wanted to ask about health information technology and privacy, but settled for a dorothy-dixer on the relationships between the NPPs and the IPPs.
NEHTA ought to be looking at the proposed
merger of Symbion and Primary. If these two health care companies become one, common business sense suggests there will be a merger of patient data onto the one database, although it may turn out only the pathology data is merged, leaving the primary care untouched. But there will be efforts to sip prescribing data from the medication and diagnosis fields, to make it available to pharmaceutical companies and third party service providers.
So, are there standards for merging databases of patients personal information? Can those standards be imposed on providers (I think I know the answer already)? If mishaps occur, leaving personal data at risk of being misused, can penalties be applied? For example, if the IT tech being pushed to do a quick and dirty merge falls asleep in the cab, and misplaces his portable hard drive, and a list of HIV-positive clients appears on the net, who gets a kicking for transporting files on an unencrypted medium? Since the banks are moving to two-factor authentication, how should health care providers authenticate themselves?
The best thing NEHTA could do is curtail some its activities and focus on urgently developing and implementing a uniform system of national provider and individual
identifiers and sort out its appalling disconnects with Medicare.
What's all this 'vendors must comply with NEHTA' stuff in State Tenders? The reality is the States will focus on getting what exists today not what some vendor might have to comply with at some distant time in the future (fairytale stuff). In truth most vendors know they need to comply with mainstream health ICT standards emerging from overseas else they won't have a future - so what is NEHTA doing? The inference that NEHTA seems to be trying to set itself up to 'write' a lot of the standards might be close to the mark. Maybe NEHTA wants to show the world how to do 'IT' properly - given the dismal outcomes in the US and UK and some might think that is not such a bad idea - but the pragmatists will say that NEHTA needs to focus more on what will give immediate benefits before getting distracted with the more esoteric things that are more pure research than anything else. Where is the light at the end of NEHTA's tunnel?
It is easy to say that “NEHTA should be working to ensure ……. quality systems are certified and health providers are able to procure / purchase them in the confidence they will be fit for purpose and deliver the benefits expected while having the basic levels of interoperability needed to enable practical information flows and clinical messaging around the health system.”
That is so much easier said than done.
Who will decide? NEHTA?
Who will accept the umpire’s decision? All States unanimously agree?! #@$% !
Vendor A passes the test, Vendor B fails the test, and Vendor C fails the test.
NSW wants Vendor B’s solutions, Victoria wants Vendor A’s solutions, and QLD wants Vendor C’s solution. Vendors B and C know their solutions are ‘better’ than Vendor A’s. NSW and QLD believe Vendor A’s solution is inferior to either Vendor B and C.
Will the umpire be heard? Will the umpire be able to enforce its decision? Will all States unanimously agree? Ahhh - now with a Federally controlled and administered hospital system …………….. say no more.
Funny you think this would be so hard given the US CCHIT (with 50 states to worry about) seems to be making a pretty good fist of it.
www.cchit.org for details.
David.
Had a closer look at www.cchit.org
There is no doubt the US CCHIT does seem to be making a good fist of it.
Makes on wonder why NEHTA doesn't follow suit - ie. embrace the CCHIT approach - OR - Have I missed something?
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